SAN PABLO -- Although health care coverage will improve and expand under the Affordable Care Act, major disparities will remain for those still uninsured, possibly with worse health care access than before, according to a new report highlighted by health advocates at a medical center here Friday.

"Our survey found that despite dramatic progress, California will continue to have a patchwork of indigent care and safety-net programs and services ... this is a pivotal time," said Anthony Wright, executive director of the Health Access Foundation.

The report comes at a time when counties are making crucial initial decisions on the scope of their safety net programs for indigent care after implementation of the Affordable Care Act.

While the law will dramatically reduce the number of uninsured, a projected 3 million to 4 million Californians will remain uninsured after the health care law is implemented, according to the report.

Counties have traditionally been the provider of last resort for those who are uninsured.

In Contra Costa County, more than 127,000 remain uninsured, about 11 percent of the population, according to the report.

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"Contra Costa has a long-standing policy to provide coverage to undocumented children (but) suspended such care for undocumented adults in 2009," the report reads. "There is limited funding that goes to community clinics to provide some care."

Under the federal health care overhaul, subsidized coverage is not available for undocumented immigrants, the largest population of people likely to remain uninsured. San Francisco and Fresno counties are among the few that provide funds for primary care for the undocumented, according to the report.

Contra Costa has an estimated 79,000 undocumented residents, according to a 2011 Public Policy Institute of California survey.

County Supervisor John Gioia, of Richmond, praised the report and the San Pablo clinic, Lifelong Medical Care, as "crucial to the safety net."

"Everyone has a right to quality health care regardless of your immigration status," Gioia said.

But capacity for providing health care is in peril.

Doctors Medical Center, a hospital across the street from the news conference that serves mostly uninsured and underinsured patients and has long been considered an important safety net for West County residents, declared a fiscal emergency this week. It is the leading source of hospital care for the area's uninsured, underinsured and Medi-Cal beneficiaries, according to a hospital news release.

The hospital's finances have deteriorated faster than previously projected because of declining patient numbers and reduced reimbursements from Medicare, widening the deficit despite the hospital shaving 6 percent off operating expenses since 2010.

Gioia signaled that he hoped that hospitals in more affluent communities would funnel resources to Doctors Medical Center to avert imminent closure.

"These (other hospitals) have an obligation and responsibility" to ensure hospitals that serve indigent populations stay open, he said.

The Affordable Care Act aims to expand health insurance to an estimated 5.3 million uninsured and eligible Californians through new exchange plans on Covered California. The state also has expanded its welfare Medi-Cal program to those with incomes below 138 percent of the poverty level.